The last shift of my tour seemed to be nothing more than one alcoholic after another. Individuals with drinking problems that go beyond binging. Emotional and psychological dependence on the stuff is what I'm talking about. This is not the same for me as picking up a gutter-vomiting teenager who needs to be taught when to stop drinking. This tugs on you and reminds you of how vulnerable humans are and where they can end up when things go wrong and they just can't cope with it all.
Before all that, I'd gone through nights and days where aggression and trauma mixed into the scheme of my world so fluently that they became one and the same.
A taxi driver crashed into a lamp-post, flattening it and continued on until he was stopped by a traffic light post, which was bent halfway by the force of the sudden deceleration. We were the second ambulance on scene and it was immediately apparent that it was not safe. The London Fire Brigade (LFB) was called because the engine was still 'live' and there was a spillage of diesel under the cab.
Inside the taxi were a driver (obviously) and a passenger. Both had been thrown forward violently by the crash but only the driver had been wearing a seat belt. However, he seemed in a worse state than his passenger, who was conscious, alert and somewhat annoyed by the situation. His neck was being held stable by a FRU pilot and one of the crew from the first ambulance on scene.
The driver had apparently been unconscious prior to crashing, according to witnesses. An off-duty doctor and paramedic both helped and they informed us that the driver had still been unconscious when they went to his aid immediately after the incident had occurred This was a worrying bit of information, so I asked for an ECG to be done and a full set of vitals before we moved him.
The LFB had arrived after a few minutes and they were very keen to cut the doors off the cab (this was going to be the extrication method) but I'd asked them to hold fire until I'd seen what was going on with the man's heart.
A few years ago I was called to a crash where the driver had lost consciousness at the wheel and careered into a barrier. His ECG revealed a massive heart attack. I was determined to check this before we did anything else.
The driver's ECG was fairly normal but his blood pressure was consistently high. He had a history of hypertension and a stroke in the past. This seemed to be the only rational medical explanation, so we carefully removed him from the cab first, followed rapidly by his passenger. Both went to the same hospital and both landed in Resus, but the passenger walked out after a short time because he was 'fed up', apparently. The driver was found to have had a stroke and was taken to a specialist unit for treatment.
We were asked to take a 30 year-old male from police custody to hospital because he'd admitted to having swallowed drugs (allegedly). However, when we turned up, he denied it and became extremely verbally aggressive towards us and the officers. In fact, all the way to hospital, even with a police officer in the back with him, he shouted abuse and hatred at me. He made several statements about how we (paramedics) were all 'worthless' and a 'waste of time'. It felt very personal, even though I knew it wasn't but it's extremely hard for someone like me to keep a 'yes sir, no sir' attitude with an individual like this. There are things I want to say but they'd get me sacked. So, I endured and allowed him to berate me, my colleagues and my Service, until he was exhausted by his own venom.
Then a drunken Italian man continued the abuse and added physical aggression to the equation.
We'd picked him off the street after a concerned MOP had called us. Initially he was just annoyingly vociferous but it did't take too long before the drunken stares began... these are usually followed by insults and challenges. I wasn't attending this patient but I got as much of the offensive stuff as my crew mate. The man obviously wasn't fussed.
We tried to put him somewhere quiet to sleep it off because he didn't need to go to hospital. If we'd taken him (even if we'd managed to get that far without him kicking off in the back), he'd have upset every proper patient there and probably caused grief for the staff. I don't like giving hospital staff the same stuff we have to put up with. So, we tried to sit him outside the hostel we thought he stayed at.
He fell over and looked like he was going to keep falling over until someone else called 999 and another crew had to experience his violence. So, we got him back into the ambulance, after a few swipes and punches, and took him to the police station. We asked an officer if he could be arrested for drunk and disorderly behaviour but the cop wasn't having it... they were full up and had many other drunks to deal with.
Suddenly, as if by magic, the man uttered the name of the hostel he was actually staying at. We decided to take him home and leave him with staff who knew him better. The journey wasn't too far but he shouted at and insulted us all the way there.
When we tried to walk him to his hostel, he became very aggressive and his arms swung at us. So, I went to the hostel and got the manager to come and collect him. This worked (eventually) and we finally got rid of our cargo.
Ironically, I was told by the manager that the man didn't usually drink and that he was normally very quiet and gentle as a lamb. Alcohol has a way of stripping away the human side.
I got chatting to a lovely 74 year-old lady who works in the theatre (she still teaches young Thespians) after we'd been asked to take her to hospital following a fall in the street. I suspected she had a broken nose, so an x-ray was needed at the very least. She was quite embarrassed about an ambulance coming for her and said "I thought they'd send a bicycle".
We talked about Groucho Marx and 'The Broons' from our lives in Scotland (she was from Edinburgh). It was refreshing to meet a patient like this after the night we'd had so far.
Our only true emergency of the shift was an 88 year-old female who'd had a recent chest infection and who could barely breathe. We had to take her into Resus on blue lights. Her condition was serious but when I saw her later on she was a completely different person; normal colour and breathing well again.
The first alcoholic we dealt with was a 53 year-old female who was shouting the odds when we arrived. Her carer looked terrified - she'd called 111 and was directed to 999 (this happens a LOT), so we had to attend.
The woman was drunk. She had no immediate medical issues but she had a long history of physical and emotional problems. She'd lost a few important people in her life and everything had spiralled out of control.
She didn't need or want to go to hospital and we could see that she had en extensive history of having ambulances come to her and then leave without taking her in. Dozens of calls like this had resulted in absolutely nothing being done about the problem.
It was very clear that she had mental health problems but that they are not being addressed, simply because she gets drunk and then refuses all help. This cycle has to be broken before she will get any better. Until then, thousands of pounds of tax payers money will be spent allowing her to continue on until she kills herself, dies accidentally or kills others by misadventure. She smokes a lot and it doesn't take a genius to see that if she is drunk enough and drops her cigarette on the floor, among the debris of cooking fat, paper and alcohol, she will burn... and so will her flat, and the flats above hers. It's happened before. It's a fairly reasonable prediction.
In the end we had to leave her, after an hour of chatting and trying to persuade her to go somewhere safe with us. Her sister arrived and sat with her and this woman made me think harder about it all. She was very defensive with me, very agitated and laughed almost manically when she spoke of her sister's condition. It was clear that the poor woman was reaching (if not at) the end of her rope. From what she said to me, nobody had shown any real interest in her sister's problems. I could see the depth of her hopelessness and I wondered how easy it was to get there.
Nobody seems to care. Her GP and the other services are trying everything they can but there seems to be no solution. That just can't be right. At the very least, a Section for her safety should be considered.
Our second alcoholic is someone I know. I've attended to her several times. On each occasion, she leaves hospital without treatment, begs for money on the street and then goes to the nearest shop to buy booze to keep herself drunk. It's not unusual to attend more than two or three times in a single day because if she doesn't call us, a MOP will. It goes on and on.
She is very well spoken 61 year-old woman and she always says that she knows what a burden she's become and that she wants to end her own life. This is pretty much what they all say but the reality is they want help. REAL help. They don't need us taking them on pointless runs to A&E and they don't want pity or anger or hatred.
Economically, it would be far cheaper to give them the help they need. Take them away from their environment and all alcohol for as long as it takes. Give them new purpose. Instead, we just keep chucking money at the problem without reaching a valid resolution.
I'm not being Utopian, believe me, but up close and personal... these are vulnerable people with nowhere to turn except us. We are NOT Social Services, neither are we the AA or any other agency responsible for this kind of support. It's time we looked at this again.